News Article

WMiC, Issue 16 - Social Care Spending in the West Midlands - a system in need of some TLC

Growing pains and last legs

The BBC recently ran a report on the high turn-over rate of workers in the adult care sector. It was one of a spate of reports from different sources that have been painting a dispiriting picture. Using data from the charity Skills for Care, the broadcaster found that out of a workforce of 1.3 million, an estimated 338,500 left their jobs in 2015-16, a rate equivalent to 928 workers a day. At the same time they found a shortage of around 84,000 care workers, meaning about one in 20 posts were left vacant. With one in four care workers on a zero hour contract and a full-time, frontline care worker earning little more that half the UK mean salary, perhaps this is unsurprising. Further emphasising the difficulty of retaining people in the sector, the Communities and Local Government Select Committee independently reported on a turnover rate of social work nurses of around 36% and that 48% of care workers leave within a year of starting.

Notwithstanding the recruitment and retention issues, demand is only set to grow. By way of context, the Office of National Statistics’ UK wide figures show that between 2005 and 2015 the number of men aged 85 and over had increased by 54% and by 21% for women. Alongside this growth in demand, the National Audit Office has estimated that government grants to councils fell by 37% between 2010-11 and 2015-16. While their figures also suggest councils have tried to protect social care spending, according to the Institute of Fiscal Studies (IFS) these combined pressures have generally led to a reduction in social care spending per adult. So much so that the Commons inquiry into social care stated clearly that “unless significant extra funds are provided in the short and medium terms, the social care system will be unable to cope with the demands placed upon it”, without it “the other steps we have suggested will quite simply fail”.

IFS and buts

Looking at how adult care spending has changed in England since 2009-10, the IFS found that in 2015-16 around £380 per adult resident was spent on adult social care. As might be expected this varied from place to place, so that 10% of councils spent less than £325 per adult and 10% more than £445. The extent of the changes in spending also varied, so that the 10% of authorities that made the biggest cuts saw their per-adult spending fall by 31% between 2009-10 and 2015-16; and the 10% of councils with the biggest increases in spending averaged a 7% rise. Aggregated regionally, spending fell across the country, with the West Midlands experiencing one of the sharpest reductions, falling by 17% in six years.

Region

Spending per adult 2009 - 10

Spending per adult 2015-16

Percentage change per adult

North East

479

395

-18%

London

475

389

-18%

West Midlands

440

366

-17%

North West

448

389

-13%

East Midlands

394

356

-10%

East of England

435

396

-9%

South East

407

380

-7%

Yorkshire and the Humber

388

361

-7%

South West

401

395

-2%

All costs 2016- 17 prices

Source - IFS 2017

The IFS took a detailed look at some of the factors accounting for the variations in expenditure at local authority level. Among the more general factors was the ending of the system that updated the local needs’ assessment for government grants, noting that the cuts “to LA budgets have fallen much heavier on those relatively poorer, more needy areas that depend more on central government grants”. As a result, areas that had higher levels of deprivation, more working-age disability claimants and more adults on pension credit as assessed in 2009-10, have tended to make larger cuts to their adult social care spending. On average, spending fell most in London and in the metropolitan districts and more in the north than in the south of England.

Select Committee consensus

With less money to go round, the CLG Committee found that councils had responded by providing care and support to fewer people and concentrating on those with the highest needs. In an increasingly “price first, quality second approach” it seems provision had too often become “the minimum required for a person to get through the day”. As echoed in the BBC report, they found issues with some councils’ dealings with providers, quoting accounts of councils paying as little as £2.24 an hour for residential care.

The Government’s commitment to an additional £2 billion over three years, though welcome, was still considered insufficient to deal with the scale of the on-going issues. To set the system onto a sustainable long-term path, they suggested that “expenditure on adult social care will need to rise as a proportion of total public spending” and called for an urgent review. With the Government announcing a green paper on social care funding, among the Committee’s recommendations are that it should involve political parties from “across the spectrum”, the social care sector and the public “in the process of reaching a solution”. Taking an “all options are on the table” approach, they suggest investigating sources such as hypothecating national taxation, looking at all age-related expenditure including pensions and winter fuel allowances, and the potential of compulsory insurance schemes, as well as looking at the role of local taxes and the differences in how individuals should contribute to the cost of their care. In considering the likelihood of reaching a cross-party approach, the House of Lords Committee on the long term sustainability of the NHS, had reinforced its importance, saying “a political consensus on the future of the NHS and social care is not only desirable, it is achievable”.

Integration - no silver bullet

With similar cost and demand pressures being experienced in the NHS, a great deal of hope is being invested in the rewards that better integration between health and social care services might bring both from the perspective of the user and in terms of organisational efficiency. Supporting a more locally joined up approach to health and social care budgets, the Committee nonetheless suggest that the Government should be “realistic” about what integration can achieve while being more active in removing the barriers to integration. In moving forwards they call for the decisions on pooling health and social care budgets to be made locally with councils involved in the commissioning of health services to ensure that they are informed by local needs and existing local services.

The National Audit Office (NAO) has also looked in detail at some of the issues, noting that integration would be difficult in “normal times, let alone when both sectors are under such severe pressure”. Sounding a note of caution they found that moves to integration, largely through the Better Care Fund, have so far fallen “far short of plans, despite much effort”, with the Fund not achieving “the expected value for money, in terms of savings, outcomes for patients or reduced hospital activity”. Indeed, in comparing the first year of the scheme with the previous year, they found emergency admissions had increased by 87,000, when the target had been to reduce them by more than 100,000. Similarly, the number of days lost to delayed transfers of care rose by 185,000, when a reduction of over 290,000 was planned for. The combined additional cost from both overshoots was over £450 million.

That said, the NAO pointed to successes, including reducing permanent admissions of those aged 65 and over into residential and nursing care homes. Importantly, they also found that it has helped local areas work together across health and social care, noting the “general agreement” that place-based planning is the right way to manage scarce resources at a “system wide level”. However, as a number of reports suggest, although it may well be the best way forward, it seems unlikely that it will be able to square the circle of growing demand and increasing budgetary pressures on its own.